Carrier Leasing Network — Interactive Graph
Arrows show who leases whose network. Click any carrier node to see its full relationship profile. Drag nodes to reposition. Edge color = reimbursement impact direction.
🔍
Provider revenue loss
Neutral / comparable
Provider gain
Variable
Ended 2025
Carrier-to-Carrier Leasing Map + Reimbursement Impact
Each row shows a leasing relationship plus the estimated reimbursement impact on providers. Impact = difference between the lessor's fee schedule and what the lessee would otherwise pay its network.
⚠️ The dominant pattern: In 11 of 18 active arrangements, the lessee's patients are being processed at a fee schedule LOWER than the lessee's own rates would be. Lessees structurally prefer lower-cost lessors — that's the economic logic of leasing. The provider absorbs the delta.
Provider Revenue Loss — lessor's fees below lessee's own schedule
Neutral — comparable fee schedule tiers
Provider Revenue Gain — rare, lessor pays more
Variable — market-dependent or plan-type-dependent
Confirmed Sourced from carrier portal, ADA, or official announcement
High Prob Industry-documented, not officially announced
Suspected Inferred from EOB patterns / provider reports
| Lessor (Owner) ↕ | Lessee (Accesses) ↕ | Confidence ↕ | Effective ↕ | Status ↕ | Reimbursement Impact | Notes | Opt-Out |
|---|
Umbrella & Wholesale Network Operators
These entities aggregate provider contracts and lease access wholesale to dozens of carriers and TPAs. Impact column shows directional fee schedule effect on providers under each access pathway.
MetLife PDP
Preferred Dentist Program — MetLife's owned network, now licensed out
Fee Tier: Below Average
Aetna
Effective 9/1/2025. Aetna patients at MetLife-contracted providers get MetLife PDP rates, not Aetna's schedule.
−10–20%
Guardian
Ongoing. Guardian patients processed at MetLife PDP schedule. Both carriers are lower-tier but MetLife is consistently cited lower.
−5–15%
Ameritas
Ongoing. Ameritas mid-range vs MetLife PDP below-average.
−5–10%
Sun Life / DHA
Effective 10/18/2025. Sun Life mid-range vs MetLife PDP below-average.
−10–15%
Cigna Shared Administration
Cigna's PPO — now licensed to third parties via SAR program
Fee Tier: Below Average (declining)
Humana (eff. 11/1/2025)
Cigna new agreements require ~40% w/o vs Humana's ~30-35%. Providers lose on Humana patients processed at Cigna rates.
−5–15%
Ameritas (eff. 11/1/2025)
Cigna and Ameritas are comparable tier; Cigna's network add is ~4–6K providers. Impact primarily geographic, not fee-differential.
~Neutral
Sun Life / DHA (eff. 3/1/2025)
Bidirectional. Cigna patients access DHA providers at DHA/Sun Life rates (mid-range, comparable). DHA patients access Cigna at Cigna rates (slightly lower in some markets).
~Neutral
GEHA (ended 1/1/2025)
GEHA was accessing Cigna's network. Terminated January 1, 2025. Providers who'd been in-network for GEHA via Cigna may have lost that pathway.
Ended
GEHA Connection Dental (CDN)
Operated by Gov't Employees Health Association since 1937
Fee Tier: Above Average (federal schedule pays above commercial)
Aetna MA Dental (eff. 9/1/2025)
Aetna's Medicare Advantage dental now routes exclusively via direct PPO or Connection Dental (all other lease pathways terminated). CDN federal rates reimburse at or above Aetna's commercial schedule — providers at CDN-contracted practices receive better reimbursement for Aetna MA patients than Aetna's own MA rates.
+8–15%
Cigna Dental (eff. 8/1/2023)
CDN federal rates are above Cigna commercial. Cigna members at CDN-contracted providers get CDN's higher federal rates — a provider-friendly arrangement given Cigna's ~40% write-off schedule.
+10–20%
Ameritas / Dental Select
CDN federal schedule at or above Ameritas mid-range. Ameritas patients at CDN providers may see slightly better reimbursement than Ameritas' own schedule. Excludes Utah.
+5–12%
Humana CarePlus (MA)
Medicare Advantage plan accessing CDN. CDN federal rates are above typical MA dental reimbursement — providers at CDN practices benefit vs standard Humana MA rates.
+8–15%
Guardian (ended April 2025)
Guardian terminated CDN in multiple regions. Providers who were in-network with Guardian via CDN may now be out-of-network for Guardian in those regions.
Ended ⚠️
DenteMax / DNoA
Dental Network of America — acquired DenteMax; 200+ lessee carriers
Fee Tier: Mid-Range
United Concordia (Advantage Plus)
2014 DNoA partnership. UC Advantage Plus providers accessible via DenteMax. Both mid-range; minimal fee differential.
~Neutral
Beam Dental
Beam has no owned network — all members served via DenteMax, First Dental Health, Stratose, Plusnetwork. Beam is a startup carrier; rate levels align with DenteMax mid-range.
~Neutral
Mutual of Omaha
Confirmed in NC state filing. Mutual accesses DenteMax via DHA's arrangement with DenteMax. Both mid-range.
~Neutral
Equitable Financial
Accesses DenteMax Plus Network via DHA's existing DenteMax arrangement (eff. 7/1/2022). DenteMax mid-range; Equitable historically competitive.
~Neutral
~200 carriers + TPAs (not fully disclosed)
DenteMax markets itself as a network lessor to insurance companies, TPAs, and self-funded employer groups. Full lessee list not publicly disclosed.
Various
Dental Health Alliance (DHA)
Sun Life subsidiary — 8 distinct access pathways per July 2025 payor list
Fee Tier: Mid-Range
Aetna (via bilateral arrangement)
Aetna Life Insurance Company accesses DHA via bilateral arrangement. DHA mid-range fees; Aetna mid-range. Comparable tier — minimal impact.
~Neutral
UHC / Dental Benefit Providers (35+ entities)
All UHC plan families (UnitedHealthcare, Oxford, UMR, Rocky Mountain HMO) access DHA via DBP arrangement. UHC is mid-range; DHA is mid-range. Impact neutral to slightly positive.
~Neutral
United Concordia + Highmark (all entities)
United Concordia Companies, UC Dental Corp of Alabama, UC Life & Health, UC Insurance Co of NY, plus all Highmark BCBS entities access DHA via bilateral. High-volume government/FEHB carrier.
~Neutral
Humana (all dental entities)
HumanaDental, Humana Insurance, CompBenefits, The Dental Concern all access DHA. Humana mid-range; DHA mid-range. Neutral.
~Neutral
Cigna (via bilateral)
Both Cigna Health and Life + Connecticut General Life access DHA. Cigna below-average fees; DHA mid-range. Providers receiving Cigna patients via DHA get Cigna rates — slight loss vs DHA rates.
−5–10%
MetLife (Metropolitan Life)
MetLife accesses DHA. DHA is mid-range; MetLife PDP is below-average. For providers contracted with DHA, MetLife patients route at MetLife's rate — which is below DHA's schedule.
−10–15%
WellCare / Fallon Health
Both WellCare and Fallon Health access DHA via bilateral. Primarily Medicare Advantage plans. MA dental rates often below commercial.
Variable/Low
Mutual of Omaha / United of Omaha
Access DHA via DenteMax sub-lease arrangement. Both mid-range carriers; Mutual of Omaha generally competitive.
~Neutral
TPAs via Premier Dental Group
Covenant Administrators, EBSO, Meritain Health, Momentum Insurance, PreferredOne all access DHA via Premier Dental Group. Employer TPAs; generally competitive rates but varies by plan.
~Neutral
United Concordia
Highmark subsidiary — both a lessor to others and a lessee of DHA
Fee Tier: Mid-Range (UC Elite Plus / Advantage Plus)
UnitedHealthcare (eff. May 2025)
UHC accesses UC Elite Plus ONLY. Does not include FFS, ParNet, or Tricare. Tricare requires direct UC DOD contract.
~Neutral
Companion Life
UC leases its PPO network to Companion Life. UC is primary, DenteMax is fallback (confirmed via CO state filing — documented stack ranking).
~Neutral
BCBS Minnesota (Blue Cross Dental)
BC/BS MN plan docs confirm "United Concordia provides network access via Advantage Plus AXS." UC is the dental administrator for multiple BCBS plans.
~Neutral
Highmark Blue Edge Dental (all Highmark entities)
UC administers all Highmark Blue Edge Dental plans (BCBS PA, BCBS WV, BCBS WNY, BlueCross Northeast PA, BCBS DE, BlueCross of Delaware, Blue Shield). UC owns Highmark; this is an intercompany arrangement.
~Neutral
BCBS North Dakota
BCBSND confirms "United Concordia provides dental benefit administration and provider network for BCBSND dental products."
~Neutral
Careington
TPA + PPO + dental discount plan hybrid
Fee Tier: Below Average for PPO; Discount-only otherwise
Aetna Care Platinum PPO (ended 9/1/2025)
Aetna MA dental ended Careington access. Providers who relied on this pathway for Aetna patients need direct Aetna PPO contract. Careington below Aetna commercial — the termination is a net positive for providers who get direct Aetna contracts.
Ended
Guardian (ended April 2025)
Guardian terminated Careington in multiple regions. Providers who were in-network for Guardian via Careington may now be OON for Guardian in those regions.
Ended ⚠️
Remaining mid-tier carriers + employer TPAs
Careington still leases to smaller carriers and self-funded employer groups. Full active list at careington.com/providers.
Typically Loss
⚠️ Delta Dental does not lease networks. All Delta Dental plans (PPO + Premier) contract directly with every dentist in their network — no silent PPO exposure. However, their fee schedules are below what many practitioners expect: Delta Dental PPO and Premier are consistently ranked as below-average payers in industry surveys, with write-offs commonly 35–50%+ vs UCR in many markets.
Carrier Fee Schedule Intelligence
Directional fee schedule rankings based on PPO practice management research, consultant industry data, and write-off percentage benchmarks. All data is directional and national-average — actual schedules vary significantly by zip code and CDT code. Use for strategic planning, not individual claim adjudication.
💡 How to use this: The tier each carrier falls in determines whether their leasing arrangements benefit or hurt your practice. A Tier 3 lessor (low payer) leasing to a Tier 1 or Tier 2 lessee (higher payer) = provider revenue loss on those patients. Check each active leasing relationship against both carriers' tiers to estimate the directional impact.
Tier 1 — Above Average Reimbursement
Highest fee schedules nationally; providers typically write off 10–25% of UCR
GEHA Connection Dental (CDN)
Tier 1 — Above Average
Fee structureFederal FEHB schedule — at or above commercial
Typical provider write-off vs UCR10–25%
Active lesseesAetna MA, Cigna, Ameritas, Humana CarePlus
CDN's federal employee benefit plan (FEHB) fee schedule reimburses at or above commercial carrier rates. Providers at CDN-contracted practices benefit when lessee plans (Aetna MA, Cigna, Ameritas, Humana CarePlus) route claims through CDN — they receive above-average federal rates rather than those carriers' typically lower commercial schedules. Particularly strong advantage for Cigna patients given Cigna's ~40% write-off on new agreements. Source: GEHA provider fee schedule documentation; PPO Advisors.
Anthem BCBS (commercial)
Tier 1 — Above Average
Typical provider write-off vs UCR15–28%
Network leasingVaries by state plan
Key leasing noteSome BCBS plans use UC as dental admin
Anthem/BCBS commercial dental plans are among the higher-paying carriers. However, coverage varies dramatically by state plan — some BCBS state plans use United Concordia as dental administrator, which introduces leasing exposure. Always verify whether your BCBS state plan is UC-administered.
Tier 2 — Mid-Range Reimbursement
Competitive fee schedules; providers typically write off 25–38% of UCR
Aetna
Tier 2 — Mid-Range
Typical provider write-off vs UCR25–35%
OON benefit generosityHigh — 100/80/50 structure
2025 MA dental shiftMA dental → direct PPO or CDN only
Mid-range but restructuring. Aetna's Massachusetts Advantage dental in 2025 now routes exclusively via direct PPO or Connection Dental (CDN pays above-average federal rates — a provider-favorable pathway). For commercial Aetna, rates remain mid-range. PPO Advisors notes Aetna is "fairly easy to drop" due to generous OON benefits.
Humana Commercial
Tier 2 — Mid-Range
Typical provider write-off vs UCR28–38%
MA dental reimbursementBelow commercial average
Network leasing since 11/1/2025Cigna SAR access (lower-tier)
Commercial Humana is mid-range. Humana's Medicare Advantage dental is below average (typical of MA plans). The new Cigna SAR arrangement (11/1/2025) means Humana patients at Cigna-contracted providers get Cigna's below-average rate — a downgrade from Humana's own commercial schedule.
UnitedHealthcare
Tier 2 — Mid-Range
Typical provider write-off vs UCR28–36%
Network viaDBP (Dental Benefit Providers)
Elite Plus access (May 2025)Added UC Elite Plus pathway
Mid-range commercial payor. UHC's Dental Benefit Providers (DBP) subsidiary has leasing arrangements with multiple carriers including DHA. The UHC→UC Elite Plus deal (May 2025) adds another access pathway for UC providers.
United Concordia (commercial)
Tier 2 — Mid-Range
Commercial write-off vs UCR25–35%
FEHB plansAbove average — well-regarded
Stack ranking riskHigh — used as primary in many stacks
United Concordia's FEHB (federal employee) plans are above average and well-regarded. Commercial and Tricare plans are mid-range. UC is used as a primary network in documented stack ranking arrangements (Companion Life: UC → DenteMax fallback). Multiple BCBS state plans use UC as dental administrator.
Ameritas
Tier 2 — Mid-Range
Typical provider write-off vs UCR25–35%
Network expansion (11/1/2025)+4–6K providers via Cigna SAR
CDN access (lessee)Also accesses CDN (GEHA) as lessee
Ameritas is a mid-range, well-run regional carrier. The Cigna SAR expansion adds providers at comparable tier. Ameritas is also a lessee of both CDN (above-average federal rates — provider-favorable) and Cigna SAR (below-average — provider-unfavorable). Net impact depends on which arrangement applies to the claim.
Sun Life / DHA
Tier 2 — Mid-Range
Typical provider write-off vs UCR25–35%
DHA payor access8 bilateral access pathways (Jul 2025)
Exposure riskMetLife + Cigna access DHA (both lower-tier)
DHA/Sun Life is mid-range. However, because MetLife and Cigna access DHA as lessees, DHA-contracted providers are exposed to those carriers' lower fee schedules when their patients show up. The new MetLife→DHA arrangement (10/18/2025) creates a meaningful revenue leakage risk for DHA-contracted practices.
Principal Financial
Tier 2 — Mid-Range
Typical provider write-off vs UCR25–34%
Network disclosurePublicly discloses "owned + leased"
Guardian bilateral (Dec 2025)Guardian (below avg) now accesses Principal
Principal is one of the few carriers that openly discloses leasing on its website. Mid-range fee schedules. The new Guardian bilateral agreement (Dec 2025) means Principal's own network is now accessed by Guardian at Guardian's rates — creating downward pressure on Principal-contracted providers who see Guardian patients.
Mutual of Omaha
Tier 2 — Mid-Range
Typical provider write-off vs UCR26–35%
Network viaDenteMax + Connection Dental (both confirmed)
Own networkMutually Preferred℠ via DHA/DenteMax sub-lease
Mutual of Omaha accesses both DenteMax and Connection Dental, confirmed in state filings. Their Mutually Preferred℠ network is built on DHA's DenteMax arrangement. Mid-range fee schedules.
Tier 3 — Below Average Reimbursement
Lower fee schedules; providers typically write off 35–50%+ of UCR. Lease pathways through these carriers create the most provider revenue drag.
Cigna (commercial PPO)
Tier 3 — Below Average
New agreement write-off vs UCR~40% (recently increased)
Old agreement write-offWas 20–25%
OON impact if droppedSevere — patients lose most OON benefits
Cigna is "aggressively" cutting fee schedules. PPO Advisors documents new agreements requiring ~40% write-off (doubled from historical 20–25%). Dental Economics confirms Cigna has "sent letters to many doctors announcing reimbursement reductions." Difficult to drop because patients see a "dramatic drop in benefits" OON. Now leasing its network to Humana, Ameritas, and Sun Life — meaning those carriers' patients may also get Cigna's below-average rates. Source: PPO Advisors 2024, Dental Economics.
MetLife PDP
Tier 3 — Below Average
Typical provider write-off vs UCR35–45%
OON impact if droppedLow — generous OON benefits
Active lesseesAetna, Guardian, Ameritas, Sun Life
PPO Advisors directly calls out MetLife as a "major source of frustration to dental providers because of their low fee schedules." The silver lining: generous OON benefits mean practices can more easily drop MetLife without losing patients. The problem is MetLife's growing lessee roster — Aetna, Guardian, Ameritas, and Sun Life patients are now being processed at MetLife's below-average rates. Source: PPO Advisors "Going Out-of-Network" guide, 2024.
Guardian DPG / DPG Select
Tier 3 — Below Average
Typical provider write-off vs UCR33–42%
Network leasing exits (2025)Left CDN + Careington in April 2025
Guardian → Principal (Dec 2025)Guardian now accesses Principal's network
Guardian has been exiting leased network arrangements (CDN, Careington) in 2025 — which may indicate they're building or restructuring their own network. Guardian's new bilateral with Principal (Dec 2025) exposes Principal-contracted providers to Guardian's below-average rates. Guardian DPG Select is frequently cited as one of the lower-paying commercial dental carriers in industry consulting discussions.
Delta Dental PPO
Tier 3 — Below Average
Typical provider write-off vs UCR35–50%
Network leasingNone — direct contracts only
Stack ranking exposureZero
Despite its market dominance, Delta Dental PPO fee schedules are consistently below what practitioners expect. No leasing exposure (direct contracts only) but below-average reimbursement is the primary concern. Write-offs of 35–50%+ are common in many markets. Confirmed by RCM practitioner feedback.
Delta Dental Premier
Tier 3 — Below Average
Typical provider write-off vs UCR30–45%
Network leasingNone — direct contracts only
Stack ranking exposureZero
Delta Dental Premier is marketed as a premium network but reimbursement rates are below industry expectations in practice. No silent PPO exposure. The bigger concern is the fee schedule itself — not leasing arrangements. Confirmed by RCM practitioner feedback.
WellCare / Medicare Advantage Dental
Tier 3 — Below Average (MA plans)
MA dental write-off vs UCR40–55%+
Network viaDHA bilateral arrangement
TrendMA dental rates declining industry-wide
Medicare Advantage dental reimbursement is systematically below commercial rates. WellCare and Fallon access DHA providers — meaning DHA-contracted practices are exposed to MA dental rates through this pathway. This is the same issue Aetna is restructuring around in 2025: Aetna is forcing MA dental into direct contracts or CDN, away from higher-cost lease pathways.
Beam Dental
Tier 3 — Below Average
Typical provider write-off vs UCR35–45%
Own networkNone — 100% leased (DenteMax, FDH, Stratose)
Member basePrimarily employer groups, SMB-focused
Beam Dental is a digital-first insurer with no owned provider network — entirely dependent on DenteMax, First Dental Health, Stratose, and Plusnetwork. Beam's fee schedules are below average. Because Beam has no leverage in fee negotiations (they use existing umbrella contracts), providers are stuck at whatever DenteMax's blended rate schedule is for Beam plan members.
📊 Method note: Fee tier classifications are directional estimates based on: (1) PPO Advisors published write-off analysis, (2) Dental Economics carrier commentary, (3) ADA economic surveys on PPO participation, and (4) documented provider community data (Reddit r/Dentistry, dental consultant forums). Actual fee schedules vary by zip code, specialty, CDT code, and contract vintage. Use for strategic leasing analysis, not individual claim benchmarking. Zelis Network360 (used by Principal and others) provides zip-code-level fee schedule analytics for more precise analysis.
2025 Leasing Network Change Log
All confirmed carrier-to-carrier leasing changes in 2025. Sorted chronologically. Impact column indicates the directional reimbursement effect on providers. Watch for opt-out windows — most are 30–90 days before the effective date and do not re-open.
JANUARY 2025
Jan 1, 2025
GEHA Ends Access to Cigna's Network
GEHA (Connection Dental Network) had been accessing Cigna's network for its members. This arrangement terminated January 1, 2025. GEHA members no longer have access to dental providers exclusively within Cigna's network as of this date. Providers contracted with Cigna who had been seeing GEHA patients via this pathway are no longer in-network for GEHA unless they also hold a direct CDN contract.
Network exit
MARCH 2025
Mar 1, 2025
Sun Life / DHA ↔ Cigna Shared Administration (Bidirectional)
Sun Life / Dental Health Alliance providers now access the Cigna Shared Administration network, and Cigna members can access DHA providers. The bidirectional structure means providers get DHA mid-range rates for DHA patients, and Cigna's below-average rates for Cigna patients. Net impact on DHA-contracted practices: neutral-to-slightly-negative on Cigna side of the arrangement.
Opt-out: surveymonkey.com/r/CignaElections | Info: cignaforhcp.cigna.com
~Neutral
APRIL 2025
April 2025
Guardian Exits Connection Dental + Careington (Multiple Regions)
Guardian quietly terminated its network leasing agreements with both GEHA Connection Dental and Careington in multiple regions. CDN's above-average federal fee schedule was actually provider-favorable — Guardian's exit removes a beneficial pathway for providers. Careington is a discount network (below-average). Guardian exiting both may signal a network restructuring ahead of the Principal bilateral (Dec 2025). Providers who were in-network for Guardian exclusively through CDN or Careington now face out-of-network status for Guardian patients in affected regions. Verify status directly with Guardian.
Access lost
MAY 2025
May 2025
UnitedHealthcare → United Concordia Elite Plus
UHC now accesses UC Elite Plus network. Both are mid-range carriers — impact is largely neutral for providers. Critical caveat: this is Elite Plus ONLY. Does NOT include UC FFS, ParNet, or Tricare/ADDP/DOD. Tricare requires a direct UC DOD contract regardless of this arrangement. Estimated write-off differential: near zero (both mid-range).
~Neutral
SEPTEMBER 2025
Sep 1, 2025
MetLife PDP → Aetna (New Agreement)
Aetna patients at MetLife-contracted providers are now processed at MetLife's below-average fee schedule. Estimated revenue impact: -10% to -20% vs. Aetna's own schedule on affected claims. Opt-out window opened July 2025. This is the single largest new leasing arrangement in 2025 from a provider revenue-loss standpoint — Aetna is mid-range; MetLife PDP is confirmed below-average.
Opt-out: dentalprovider.metlife.com/networkswap | Aetna: 1-800-451-7715
−10–20%
Sep 1, 2025
Aetna Ends Careington Care Platinum PPO Access
Aetna's Medicare Advantage dental ended its access via Careington Care Platinum PPO. Starting Sept 1, 2025: only direct Aetna PPO contract or Connection Dental provide in-network status for Aetna MA dental. The termination of Careington access is effectively a POSITIVE for providers who get direct Aetna PPO contracts (higher rates than Careington). Net effect: practices that don't get a direct Aetna contract lose Aetna MA network status.
To maintain Aetna MA: call Aetna direct contracting 1-800-451-7715
Access shift
OCTOBER 2025
Oct 18, 2025
MetLife PDP → Sun Life / DHA (New Agreement)
MetLife's PDP network now leases to Sun Life / DHA. DHA is mid-range; MetLife PDP is below-average. DHA-contracted providers now exposed to MetLife's lower rates for Sun Life/DHA patients routed via MetLife. Estimated impact: -10% to -15% on affected claims vs. DHA's own rates. Opt-out window closed before effective date.
Sun Life opt-out: surveymonkey.com/r/2025Metlife | MetLife: dentalprovider.metlife.com/networkswap
−10–15%
NOVEMBER 2025
Nov 1, 2025
Cigna → Humana (New Agreement)
Humana patients now processed at Cigna's Shared Administration rates. Cigna requires ~40% write-off on new contracts vs. Humana's typical 30–35%. Estimated impact: -5% to -15% on affected Humana claims vs. Humana's own rates. This is a meaningful revenue delta at any volume of Humana patients. Opt-out forms available via both carriers.
Cigna opt-out: cignaforhcp.com | Humana opt-out: email dentalservice@humana.com
−5–15%
Nov 1, 2025
Cigna → Ameritas (New Agreement)
Ameritas patients now access Cigna SAR network, adding ~4,000–6,000 access points to Ameritas' network. Cigna and Ameritas are comparable fee tiers — this deal is primarily geographic network expansion with minimal fee-schedule differential for providers. The additional providers come at Cigna's contracted rates, which are slightly below Ameritas' own schedule in some markets.
Ameritas opt-out: call (800) 487-5553
~Neutral
DECEMBER 2025
Dec 1, 2025
Guardian ↔ Principal (New Bilateral Agreement)
Mutual network access: Guardian-contracted providers accessible to Principal members and vice versa. Impact varies by direction — Guardian is below-average; Principal is mid-range. Principal patients at Guardian-contracted providers get Guardian's lower rates (-5% to -15%). Guardian patients at Principal-contracted providers get Guardian's rates regardless of Principal's higher schedule — meaning Principal-contracted practices don't necessarily benefit. Opt-outs available at both carriers.
Guardian: DGPSelectNetworkOptOut@glic.com | Principal: (800) 247-4695
−5–15% (directional)
⚠️ Opt-out windows typically close 30–90 days before the effective date and do not reopen. If you miss a window, you're bound for the contract term. Monitor carrier provider newsletters and portals monthly. Subscribe to the Colleen Huff dental newsletter and Dental Economics for early alerts on new arrangements.
Stack Ranking — How Carriers Choose Which Fee Schedule to Apply
When you're accessible through multiple leasing arrangements simultaneously, carriers use an internal priority system to pick which fee schedule applies. This selection is proprietary, invisible to providers, and almost always favors the lowest available rate.
The Core Mechanism
Every carrier that participates in multiple leasing relationships has a "stack" — an ordered list of which access pathways to check, in priority order. When a claim arrives, the payer checks each pathway in the stack until it finds one that applies to the claim. The payer picks whichever pathway gives them the lowest reimbursement obligation. The provider has no visibility into which pathway was selected until the EOB arrives (and even then it's often not labeled).
Step 1
Claim arrives
Patient is a United Concordia member. Provider has 4 pathways to UC.
→
Step 2
Pathway check
UC identifies all active leased arrangements connecting to this provider: Ameritas, DenteMax, Humana, Principal.
→
Step 3
Stack ranking
UC selects the pathway with the lowest reimbursement obligation. Provider doesn't know which was selected.
→
Step 4
EOB arrives
Claim paid "in-network" — but fee schedule source is buried or unlabeled. No notification to provider.
📄 Documented example (Dental Economics): A provider contracted with Ameritas, DenteMax, Humana, and Principal can be accessed by United Concordia through all four pathways simultaneously. UC picks whichever pathway gives them the lowest rate. This example involves a single UC claim being potentially processed at four different fee schedules — UC chooses the cheapest one.
Real-World Stack Ranking (Companion Life, Colorado — Documented)
A 2025 Companion Life state filing for Colorado explicitly describes their network stack in order:
Primary
United Concordia
Claim submitted first to UC. If provider is in UC network, UC fee schedule applies.
→
Fallback
DenteMax
"If provider does not participate with United Concordia, claim is returned and submitted to DenteMax." DenteMax fee schedule then applies.
→
OON
Out-of-Network
If provider not in UC or DenteMax, claim adjudicated at out-of-network rates.
📄 Source: Companion Life Insurance Company, Colorado Network Access Plan, United Concordia CO 1, updated 02/28/2025. This is one of the rare cases where a carrier explicitly documents its stack in a state filing — most carriers do not disclose this.
How to Detect Stack Ranking Activity
The only reliable detection method is EOB auditing — compare the paid amount against every fee schedule you're contracted under and find the match. The matching fee schedule reveals which pathway was used.
Step 1 — Pull all your fee schedules
Request written fee schedules from every carrier you're contracted with — including umbrella networks. Build a reference spreadsheet by CDT code.
Step 2 — Audit EOBs by payer
For a sample month, take 20 claims per carrier. Compare the paid amount to your fee schedule spreadsheet. If the paid amount doesn't match the contracting carrier's schedule, find the match among your other contracts.
Step 3 — Identify the leak
The contract whose fee schedule matches the paid amount = the pathway being used. If it's a lower-tier contract (MetLife, CDN, Cigna, Careington), you've found a stack ranking leak.
Step 4 — Carve out the pathway
Request a carve-out from the leasing relationship. This requires negotiation with the lessor. Many carriers include carve-out rights in their provider agreements but make it difficult to execute.
Known High-Risk Stack Ranking Scenarios (2025–2026)
🔴 MetLife PDP leasing to Aetna + Guardian + Ameritas + Sun Life simultaneously
Any of these four carriers can now access your contract at MetLife's below-average rate. A practice contracted with all four directly — plus MetLife — has 5 pathways to the same patients. MetLife picks the lowest each time. Cumulative write-off differential: potentially $15,000–$50,000+ annually for a mid-volume practice.
🟠 CDN (GEHA) now serving Aetna MA + Cigna + Ameritas as lessees
CDN's above-average federal fee schedule is a provider-favorable network. A CDN-contracted practice receiving Cigna, Aetna MA, or Ameritas patients via CDN may actually see better reimbursement than those carriers' own commercial schedules — particularly for Cigna patients given Cigna's ~40% write-off on new agreements.
🟡 Guardian exiting CDN + Careington while entering Principal bilateral
Guardian's 2025 moves: exiting two below-average umbrella networks, while entering a bilateral with Principal. The net effect for providers: if you were in-network for Guardian exclusively via CDN or Careington, you may now be OON for Guardian. But if you're directly contracted with Principal, Guardian patients will now show up — at Guardian's rates, not Principal's.